House Lawmakers, Providers Clash Over Nursing Home Staffing Mandate in Hearing

Amid the House of Representatives electing a speaker after a period of chaos, federal lawmakers on Wednesday also engaged in discussion of the proposed federal nursing home minimum staffing mandate.

In a subcommittee hearing of the House Energy & Commerce Committee, critics contended that the minimum staffing rule would place an excessive burden on facilities, especially those located in rural areas with staffing shortages.

Among the lawmakers, Energy and Commerce Health Subcommittee Chair Brett Guthrie (R-KY) was among the critics of the policies under consideration, including the long-term care staffing rule.


“While well-intentioned, these rules are misguided and will ultimately threaten to undermine access to vital services that our most vulnerable rely upon,” he said in his opening remarks.

House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) also spoke out against the mandate, saying that “proposed requirements that are untenable for four out of every five nursing homes do not represent a serious solution,” and that “those who rely on skilled nursing care deserve better than a proposal that could dramatically curtail their care.”

Proponents of the rule said providers need to ramp up staffing efforts. These supporters included Shelly Hughes, a nursing home CNA from Washington state.


“On average, nursing assistants support 13 residents during a typical shift, but I’ve spoken with CNAs who have been responsible for upwards of 30 residents — alone,” she said. “The math doesn’t add up. How can you care for 30 individuals in just 12 hours?”

Ranking member Anna Eshoo (D-CA) said these issues have been plaguing the industry for two decades, noting that the National Academy of Medicine called for a minimum staffing standard 1986.

“This is not to damn the industry,” she said. “This is about improving things.”

She also noted that during the Trump administration, a de-regulation of infection control in the industry had catastrophic consequences for residents.

“One of the members mentioned walking into a nursing home and the smell of urine,” she said. “Well, you know what, if you don’t have enough people, [there’s not enough people to] take care of the people that we all say we love.”

Congressman Frank Pallone (D-PA) said that while Republicans say the mandates are unfunded, last Congress, when Democrats on the committee voted to provide states with a substantial increase in federal dollars to invest in the home- and community based- services, Republicans stood in opposition.

“Meanwhile, they’ve offered no policy proposals of their own other than weakening regulations;greater federal investment in long term care services shouldn’t be controversial,” he said. “In fact, the testimony of the Republicans’ own witness, Killingworth, suggests greater federal investment in these services is needed.”

Operator perspective on the staffing mandate

Sarah Schumann, vice president of operations at Brookside Inn in Colorado, said that despite increasing wages and incentives to recruit caregivers, there is a shortage of qualified personnel. She also expressed concerns about the negative effects the staffing mandate may have on Medicaid-dependent facilities.

In her role with Brookside Inn, Schumann oversees operations of a 120-bed skilled nursing and 32-bed post-acute rehab facility.

“You are all aware that nursing homes are facing a historic labor shortage, but the proposed staffing mandate will only make things worse,” she said. “Colorado has one of the fastest growing elderly populations, but like the rest of the nation, our caregiver workforce cannot keep pace. Our facility is doing everything we can to recruit more caregivers, but there are significant obstacles.”

She said that Brookside has increased wages by more than 40%in almost all caregiver positions, but even with higher pay and better incentives, is still facing hiring challenges simply because the number of qualified caregivers they need is not there.

“Unfortunately, we have had to turn to costly temporary staffing agencies, and these contracted licensed nurses do not know our residents like our long-term employed staff do,” she said. “We did not use agency before the pandemic, but currently at times we have no other choice.”

Many of Schumann’s points echoed those made by other nursing home leaders and advocacy groups, including the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

“My hope is that after today’s hearing, Members of Congress will continue to urge the Biden Administration to reconsider this one-size-fits-all policy and instead focus on more meaningful and comprehensive policies that will actually help long term care facilities recruit workers as well as build a strong pipeline of caregivers,” AHCA/NCAL Senior Vice President of Government Relations Clif Porter stated on Wednesday. “Nursing homes share the Biden Administration and Congress’ commitment to improving resident care, but this won’t happen through unfunded staffing mandates.”

Guthrie acknowledged that Medicaid reimbursements are not sufficient to pay wages at needed levels, and said that while he didn’t agree with everything said during the hearing, the balance of perspectives is important to create an industry that is safe for residents and fair to operators.

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